Mar 14, 2023

Peripheral
Nerves
Chu-Ling Yen, PT, PhD
School of Physical Therapy
Chang Gung University
clyen@mail.cgu.edu.tw
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 General Features
• The peripheral nerves include the cranial and spinal
nerves linking the brain and spinal cord to the
peripheral tissues

• The spinal nerves

• are formed by the union of
anterior (ventral) and
posterior (dorsal) nerve
roots
• are relatively short (less
than 1 cm) and travel
across an intervertebral
foramen

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General Features

https://www.pinterest.co.uk/pin/295126581825804638/
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General Features

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General Features
• The cells giving
rise to the motor
(efferent) nerves
to skeletal
muscles are
• α (alpha) neuron
• γ (gamma) neuron

• The α and γ neuron occupy the anterior

horn of gray matter in the spinal cord
• The neurons of the posterior horns receive
sensory information that enters the spinal
cord via the dorsal roots
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 General Features
• The spinal nerves supply
• somatic afferent [ˋæfərənt] fibers to the skin, muscle and joints
• somatic efferent [ˋɛfərənt] fibers to the skeletal muscles of trunk
and limbs

• The spinal nerves carry

visceral efferent fibers

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General Features

https://www.osmosis.org/answers/afferent-vs-efferent-neurons 7
Microscopic
Structure of
Peripheral Nerves

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• Peripheral nerves are invested with epineurium
• Each fascicle (bundles of nerve fibers) is covered by
perineurium
• Less than half of the nerve fibers are enclosed in
myelin sheaths
• The unmyelinated fibers travel along the surface of
Schwann cells

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 Myelin Formation
• The Schwann cell is the representative neuroglial cell of
the peripheral nervous system

• A mesaxon, an extension of
the Schwann cell surface
membrane, forms a spiral
sheet around the axon

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 Unmyelinated Schwann
axon cell

Myelinated nerve fiber. Unmyelinated nerve fiber.

Arrows mesaxon of the Schwann cell Blue arrows mesaxon of the Schwann cell

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 Myelin expedites condition
• In unmyelinated fibers, impulse
conduction is continuous along
the axon.
• average conduction speed :2 m/s
• In myelinated fibers, impulse
conduction leaps from node to
node
• Nodes of Ranvier are at the core of
saltatory (‘jumping’) conduction
along myelinated axons and acts as
an electrical insulator
• Maximal conduction speed: 120 m/s

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Myelin expedites conduction
• The larger the myelinated fiber, the more rapid the
conduction, because
• larger fibers have longer internodal segments and the
nerve impulses take longer ‘strides’ between nodes.
• Rule of six: the ratio between size and speed (1:6)
• a fiber of 10 µm external diameter (i.e. including myelin)
will conduct at 60 m/s
• one of 15 µm at 90 m/s

http://antranik.org/conduction-of-the-action-potential-along-the-nerve-fiber/
Classification of peripheral nerve fibers
• Peripheral nerve fibers are classified based on (1)conduction
velocities, (2)diameter, (3) unmyelinated/myelinated

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Classification of peripheral nerve fibers
• Motor fibers are classified into groups A, B, C
• Sensory fibers are classified into types I to IV

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Central nervous system–peripheral
nervous system transitional region
• Close to the brainstem and spinal cord, peripheral
nerves enter the CNS–PNS transitional zone
• Astrocyte processes
reach out of the CNS
into the peripheral
nerve rootlets and
interdigitate使叉合 with
the Schwann cells

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Degeneration and
Regeneration

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• When nerves are cut or crushed, their axons
degenerate distal to the lesions

• Regeneration in the PNS is vigorous and often

complete
• Regeneration in the CNS is neither vigorous nor
complete

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Wallerian degeneration of peripheral nerves
1. Following a crush or cut injury, the axons and myelin
sheaths distal to the cut break up into ‘ellipsoids’ within
the first 48 hours, primarily as a result of the Ca2+-
activated release of proteases蛋白酶 by Schwann cells

鑷子

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2. The debris is cleared by monocytes that enter
the damaged endoneurial sheaths from the
blood and become macrophages 巨噬細胞

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3. The macrophages are mitogenic to Schwann
cells and participate with Schwann cells to
provide trophic (feeding) and tropic (guidance)
factors for regenerating axons.

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 Regeneration of peripheral nerves
E. Following a clean cut, axons begin to sprout from the
proximal stump to the distal stump
• The sprout is mitogenic to Schwann cells which divide further

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F. Multiple branchlets extend distally
• The tips of these branchlets are called growth cones
• The growth cones is extending distally along the surface of Schwann
cells

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G. Myelination is ongoing along the proximal part of the
regenerating axon

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H. When regeneration is complete, the fiber has a normal
appearance but the myelin segments are shorter than the
originals.
Origin

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Regeneration of peripheral nerves
• Successful regeneration requires that the axons
make contact with Schwann cells of the distal stump.
• Failure to make contact
leads to production of a
pseudoneuroma,
consisting of whorls螺層
of regenerating axons
trapped in scar tissue
• Following amputation of
a limb, an amputation
pseudoneuroma can be a
source of severe pain.
http://www.tumorlibrary.com/case/detail.jsp?image_id=2325

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 Regeneration of peripheral nerves
• Following a clean cut, axons begin to sprout from the
face of the proximal stump within a few hours
• In the more common crush or tear injuries, the
sprouting may be delayed for a week

• Regeneration rate
• about 5 mm/day in the larger nerve trunks
• about 2 mm/day in the finer branches
• Functional recovery
crush injury (endoneurium preserved) > complete severance 切斷

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Degeneration in the central
nervous system
• Following injury to the white matter, distal
degeneration occurs similar to that in peripheral
nerves
• However, clearance of debris by microglial cells
and monocytes is much slower
• Debris can still be identified after 6 months in
the CNS, whereas in peripheral nerves it is
virtually cleared in 6 days.

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Regeneration in the central
nervous system
• Remarkable levels of functional recovery are
often observed after CNS lesions. However,
injured motor and sensory pathways do not
reestablish their original connections

• They regenerate for a few millimeters at most,

and synapses are on other neurons close to the
site of injury

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• Which region of gray matter in the spinal cord
contains motor neurons that innervate skeletal
muscles?

A. Ventral horn
B. Dorsal horn
C. Lateral horn
D. Lateral column

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• Which is NOT a characteristic of Wallerian
degeneration?

A. It occurs in the section of the axon proximal to the

site of injury
B. The axons and myelin sheaths distal to the cut
break up into ‘ellipsoids
C. Degradation of myelin sheath
D. Proliferation of Schwann cells

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References
1. Paul A. Young, Paul H. Young, Daniel L.
Tolbert. Basic Clinical Neuroscience.
Philadelphia : Lippincott Williams &
Wilkins, 2015.

2. Estomih Mtui. Clinical Neuroanatomy and

Neuroscience. Elsevier, 2016.

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